In the gymnastics studio lobby, my 4-year-old son stood staring mournfully at the rack of hot pink velvet leotards. "I'll never wear one of those," Sam whispered. Reluctantly, I asked, "Do you want to?" He answered, slowly and sadly, "Yes. Yes, I do."

I'd said no before, to pink dresses and sparkly lip balm. It would be so easy to say it now: "No, that's for girls. Look at what the other boys are wearing."

Other pink boys

Sam is the only boy in his gymnastics class who asks for a leotard, the only boy in his preschool who likes nail polish. It's tough on Sam, because kids make fun of him. And it's tough on me and my husband, because people question our parental judgment. Worse, we fear for Sam's safety.

While looking for a ballet class where Sam could wear his tutu, I met another mom of a boy like Sam. She told me about a group of parents of pink boys and tomboys who e-mail every day on an electronic listserv hosted by the Outreach Program for Children with Gender-Variant Behaviors and Their Families, a program of Children's National Medical Center in Washington, D.C.

The program, started by child psychiatrist Edgardo Menvielle and psychotherapist Catherine Tuerk, is the first of its kind. Tuerk's own gender-variant son was born in 1968, and she and her husband spent many painful years discouraging his desire for Barbie dolls and dresses.

More than 200 families communicate via the listserv. The program also connects parents with face-to-face groups across North America and publishes a parent guide. Their message is twofold: accept your child, and teach him or her to survive in a hostile world.

Not an easy road

On the listserv, I met the Iorillo family from Boston. "There was always something different about Tony," Gloria Iorillo tells me about one of her 9-year-old fraternal twin sons. At 2, Tony twirled around the living room pretending to wear a dress, and turned Gloria's curtains into "long hair." Tony preferred his sister's girlie toys to his twin brother's trucks.

Gloria and her husband were raised in traditional, Catholic homes, and were unnerved by these persistent behaviors. "I steered him firmly toward more typical boy things. I thought I was teaching him ... appropriate behavior."

But Tony became defiant and difficult, and the feminine behaviors escalated. He started kindergarten with a pink lunchbox and a girlie T-shirt; he was Tinker Bell for Halloween. At Christmas, Tony asked Santa to make him a girl. Gloria wondered, "Why don't I have to teach my other son [how to be a boy], and I have to teach Tony?"

One day, Tony tried on his sister's dress-up clothes. "I ... freaked out," recalls Gloria. "I said 'No! You can't put that on.' He started to cry, and asked, 'Why?' I said, 'Because you have a penis, and you're a boy.' And he said, 'But I love these clothes, Mommy. I want to be a girl.' "

What does it mean?

Parents of gender-variant kids are often asked -- by family, friends and strangers -- if their children are gay or transgender. It's an impossible question to answer.

While the correlations between biological sex, gender identity and sexual orientation have not been extensively studied, experts rely on the research of psychiatrist Richard Green from the 1960s and '70s. Over a 15-year period, Green studied two groups of boys: one gender-variant and one typically masculine. He published his findings in the 1987 book, "The 'Sissy Boy Syndrome' and the Development of Homosexuality." The first group, 66 boys in all, preferred girls' clothes and toys, gentle play with girls and identifying as female characters in imaginative play. The second group, of 56 boys, preferred boys' clothes and toys, rough-and-tumble play with boys and male characters.

Three-quarters of the "feminine" group that was followed to young adulthood was gay or bisexual; one was transgender. All but one of the masculine group was straight. Green's study, while flawed and dated, says this: Gender-variant boys are likely, but not overwhelmingly, to be gay; they rarely grow up to be transgender.

The truth is, no one can tell by looking at the clothing or hairstyle of a child how the distinct elements of their gender, identity and sexuality will come together. "This is something nobody can predict," Menvielle says. "We have to be open to changes -- or no changes -- in the variety of ways the life of a child may unfold."

Whose fault is it?

When a pair of twins, raised in the same environment, come out so differently, it's hard to imagine that the child's parents could have influenced their gender behaviors. Yet this is something that many parents worry about.

Computer professional George Bley of Brooklyn, describes himself and his wife as "normal, heterosexual, boring-type people." Their 8-year-old son Max has long hair and presents like a girl. At 5, Max cried himself to sleep at night, wailing, "Why didn't Mommy make me a girl?" George fears that he somehow caused Max's gender variance by not conforming to stereotypes himself. "Maybe if I liked sports more, or if [my wife] was home cooking more, or if I was a lumberjack ..."

Many parents share similar fears. Mothers who used fertility drugs or egg donors worry about pre-conception hormones; one mom imagines an illness during pregnancy must be the cause; one father thinks it was because he had wanted a baby girl. While such questions weigh heavily on parents' minds, there is no evidence that parents or the environment have anything to do with a child's fundamental gender identity.

Dr. Herb Schreier, child psychiatrist at Children's Hospital & Research Center Oakland, has been working with gender-variant children for 20 years. "One look at the families (of gender-variant children) and you see these behaviors are not coming from Mom and Dad. This is simply a natural variation."

Can we, should we, 'fix' them?

Parents on the listserv frequently report hearing the admonishment "Stop encouraging him." It sometimes appears to outsiders that all that is needed to make a child conform to traditional gender norms is some discouragement. This idea is linked to the notion that these children will be gay adults and that changing their gender expression in childhood will prevent that outcome. But there is no indication that such an approach works -- and there is plenty of evidence that it is harmful.

The American Psychiatric Association removed homosexuality as a mental illness from their Diagnostic and Statistical Manual of Mental Disorders, or DSM, in 1973. In a peculiar twist, a diagnosis of childhood mental illness called gender identity disorder (GID) was added to the DSM that same year. A child is considered to have this disorder if he or she wants to wear the clothes of, participate in the games of, form friendships with and in some cases be, the opposite gender. When I first read the entry, I thought: That's Sam.

The Green study indicates that GID is often a precursor to adult homosexuality. While the APA continues to assert that homosexuality is not pathological, the inclusion of GID in the DSM implies that "pre-homosexuality" in children is. But, as with adults, scientific evidence of efficacy of "treatment" is lacking, and evidence of harm has been proven.

When parents seek mental health consultations for their child's gender-variant behaviors, they are often told, Menvielle says, to restrict "gender inappropriate" activities: "Throw away his Barbies; make her wear a dress." But children do poorly with that approach. "What typically happens is kids get very upset, very secretive," he says. Changing their deepest desires "is not something that works. We never see that. We see kids who are depressed, or very angry, or shut themselves in their room and play secretly, or have suicidal thoughts."

The Family Acceptance Project, conducted by Dr. Caitlin Ryan at San Francisco State University, examines how family attitudes affect the health, mental health and well-being of lesbian, gay, bisexual and transgender young people. The study (publication forthcoming) shows that LGBT young adults who experienced high levels of parental pressure regarding gender conformity report significantly higher levels of depression, illegal drug use, suicide attempts and unsafe sex than their peers who report little or no pressure.

"Parents want the best for their children," says Ryan. Those who try to suppress gender-variant behaviors "may think they're helping their child survive, but really they're forcing them to devalue a core part of who they are -- which will ultimately hurt them, and increase their risk."

Mainstream medicine now understands that homosexuality is a normal variation of human sexuality. So why is GID still considered a disorder? The diagnosis states, "The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning." In other words, it's tough to be different. Bley, who believes there is nothing wrong with his son, Max, jokes darkly, "We could call it persecuted minority syndrome: people need therapy because the rest of us are mean to them."

Let pink be

Most people don't like being different in ways they haven't chosen; parents understand that the life of a gender-variant child may not be as easy as a conventional life. But given that being gay -- only one of several potential outcomes for pink boys -- is a natural variation of human sexuality that cannot be "cured," what are we afraid will happen if we let a little boy wear the proverbial pink leotard?

Many parents, despite initial reactions of surprise or distress, have found that affirming and supporting their gender-variant child leads to positive outcomes. When Gloria's son Tony told her that he wanted to be a girl, "I flipped," she remembers. After learning about gender variance, Gloria decided to allow Tony to wear what he wanted at home, and bought him his own girl toys. She told him, " 'I didn't know that little boys would like this so much. I understand that now.' And he just gave me the biggest grin, and hugged me and immediately went and grabbed his sister's dress, and didn't take it off the whole day."

Gloria's husband, Emile, "was very reluctant at the beginning." One night, "I told Emile that if we don't support Tony, we're going to lose him. There's an elevated risk of suicide and depression. We can't let that happen."

The next morning, Tony sat drawing at the kitchen table on paper he'd divided in two. On one side, he drew himself as a girl alongside his sister, his mother and a happy, shining sun. On the other side, he drew his father, his brother and dark rain clouds. Emile got it.

When his father began to accept him, the change in Tony was significant. After behavior issues and extreme jealousy of his sister, Gloria reports, "he became very loving toward his sister. ... They started to play together all the time ... giggling with delight. It was music to my ears! He calmed down, he was at peace with himself and the world."

Parenting a gender-variant child is challenging, Gloria says, not because there's anything wrong with the child "but because of how they are perceived, and how our parenting skills are perceived, and how our morality is perceived." But, she says of Tony, "We are blessed to have him. He has changed our lives. He has opened our eyes."

From her new vantage point, Gloria believes that gender-variant children need extra support because of the challenges they will face. "If we don't make them strong, they are going to fail. And the only way to make them strong is to make them feel proud of who they are. There is no other way."

Back at the gym

The longing in Sam's face that afternoon was so intense, the certainty that he could not wear that pink leotard so embedded in his features, that I decided to say it: Yes. One brief word, and that boy lit up in a way I rarely see.

Once he'd wriggled into the leotard, a little girl looked at him and said in a superior, I'm-a-teenager-in-a-5-year-old's-body tone, "He's going to wear that?" I said, cheerfully, "Yes, he is!" She looked down her nose and said "Weird!"

Sam seemed unfazed by the girl's intolerance, and did well that day in his leotard. He does well most days in his leotard. It's still not easy, for Sam or for us, but it's worth it to let him be who he so clearly is.

And it turns out, Sam looks gorgeous in a leotard. Hot pink is really his color.

Names, places and other identifying details in this article (including the writer's name) have been changed to protect the identities and safety of the children and their families.

What is gender variance?

According to the Children's National Medical Center, gender-variant behaviors refer to strong and persistent gender-typed actions and interests typical of the other sex. It may be expressed in behaviors such as choices in clothing, games, or playmates, and verbalization of a wish to be of the other sex.

Some experts used to believe that gender variance represented abnormal development, but today many have come to believe that children with gender-variant behaviors are normal children with unique qualities -- just as children who develop left-handedness are normal.

What if there were more than two?

People who feel they don't fit perfectly into the popular culture's definitions of "male" and "female" sometimes lament that our binary gender system is too limiting. Australian cultural anthropologist Sharyn Graham Davies explores a culture that recognizes five distinct genders in her book "Challenging Gender Norms: Five Genders Among the Bugis in Indonesia." These include makkunrai (feminine woman), calabai (feminine man), calalai (masculine female), oroané (masculine man), and bissu (embodying both male and female energies, revered as a shaman).

Davies writes of the Bugi belief -- contrary to much of Western thought -- that one's gender, even if different from one's biological sex, is unalterable, predetermined by God. One calalai explained, "If your kodrat (fate) is to be calalai, you have no option but to be calalai." -- S.H.

Resources

Outreach Program for Children with Gender-Variant Behaviors and Their Families